All rights reserved. Current options include canal-based stenting (iStent by Glaukos and Hydrus by Ivantis), viscodilation devices (Omni by Sight Sciences and ABiC by Ellex), excisional goniotomy (Kahook Dual Blade by New World Medical), and a cautery device (Trabectome by MicroSurgical Technology). It’s certainly a quality-of-life boost. At three years postop, the mean IOP was reduced by 42 percent to 14.6 ±2.0 mmHg (p<0.0001) and 87.9 percent of eyes achieved an IOP reduction of ≥ 20 percent. Since the evidence of the iStent inject is attaining better outflow via improved access to the collector channels, surgeons may wonder about the relative merits of the iStent inject compared to the Hydrus, which should provide even greater access to the channels, at least in theory. Saturday & Sunday: 11:00AM–3:00PM. In addition, 97 percent of eyes reached an IOP of ≤ 18 mmHg (vs. 9.1 percent preoperatively; p<0.0001) and 70 percent of eyes reached IOP ≤ 15 mmHg (vs. 2.3 percent preoperatively; p<0.0001). Minimally-invasive glaucoma surgery is intended to lower intraocular pressure with less tissue disruption than traditional glaucoma surgeries. 9001 Wilshire Blvd. “I use the Dual Blade for my angle procedures, and sometimes combine it with endocyclophotocoagulation, which I consider a minimally invasive approach. The safety profiles of the two devices were similar.
“The data from the device studies show 1.6 and 2.2 as the delta vs. cataract surgery,” he says. 31824 Village Center Rd. “Glaukos and others are developing suprachoroidal stents, so I think we’ll see the suprachoroidal pathway come back as another option,” he says. (The Allergan Xen was voluntarily recalled in October 2019, and surgeons were told not to implant more of them; there’s been no word when surgeons can purchase new ones to implant.). “I’ve had good success with all of the blade procedures and goniotomy procedures in high myopes, especially if they have a moderately high IOP. Here, glaucoma experts share their thoughts on how they use the available devices, and we take a look at some of the results the devices are capable of achieving. M inimally-invasive glaucoma surgery is intended to lower intraocular pressure with less tissue disruption than traditional glaucoma surgeries. Mean medication burden decreased by 82 percent to 0.55 ±0.79 (p<0.0001), and 61 percent of eyes were medication-free. Preop, the mean IOP was 17.1 ±4.7 mmHg and the mean number of glaucoma medications was 2.4 ±1.3. The technique has been shown in studies to reduce the need for taking glaucoma drops and the majority of patients are off drops altogether. Hydrus Minimally Invasive Glaucoma Surgery (MIGS) This minimally invasive technique, the Hydrus stent is highly effective in reducing pressure in those with glaucoma. This is our best option, because there are no definitive studies comparing them to each other.” REVIEW. Dr. Seibold believes that MIGS procedures will gain popularity. According to E. Randy Craven, MD, associate professor and director of the Wilmer Eye Institute, Johns Hopkins Medicine satellite office in Bethesda, Maryland, when evaluating glaucoma patients, ophthalmologists first need to consider whether or not they’ll be undergoing cataract surgery. Dr. Brown emphasizes that now the various approved options are being tested. “Often, when surgeons are adept at many of these techniques, it comes down to economics,” says Dr. Kahook. It’s a fairly straightforward procedure to teach my fellows. Journal Highlights. Complete surgical success was defined as freedom from repeat glaucoma surgery, IOP ≤18 mm Hg, and no need for glaucoma medication. 1. This may be a good place to introduce yourself and your site or include some credits. • An overall safety profile that was similar to cataract surgery alone.3. “I had a chance to do that in Saudi Arabia where it’s approved. Hydrus vs iStent. For patients who undergo cataract surgery, Dr. Craven says he still can’t predict whether or not a trabecular bypass procedure is going to work. The COMPARE study was the first to compare two different MIGS devices in standalone surgery, rather than in combination with phacoemulsification. The Hydrus also was associated with reduced need for glaucoma medication (p = .004); more Hydrus subjects were completely free of such medication by month 12 (p = .0057). “It’s very empirical. Hydrus to the iStent used the original iStent, not the iStent inject. Ahmed et al. Secondary glaucoma surgery was required for two eyes in the iStent group (3.9%) and none in the Hydrus group. 1 Data on-file, Ivantis.
“In the Hydrus, we’re manipulating 8 mm of the canal in a very important region,” “As a result, there could be some fibrosis over time that might not occur with a very stealthy implantation like the iStent inject, which is very tissue-friendly and maintains the normal architecture of the canal as much as possible. Dr. Kahook receives royalties from and consults for Alcon, New World Medical and J&J Vision. “I think the innovation represented by these new devices and procedures has sort of outstripped our ability to fully assess the effects of each one,” says Leonard K. Seibold, MD, an associate professor of ophthalmology at the University of Colorado School of Medicine. Ophthalmology, January 2020. Current options include canal-based stenting (iStent by Glaukos and Hydrus by Ivantis), viscodilation devices (Omni by Sight Sciences and ABiC by Ellex), excisional goniotomy (Kahook Dual Blade by New World Medical), and a cautery device … “That’s a lot of work and explanation to patients for a relatively small change in pressure. Second-generation trabecular micro-bypass stents as standalone treatment for glaucoma: A 36-month prospective study. KDB goniotomy was combined with cataract surgery in 100 eyes.2 The main outcome measures were postop IOP and the number of IOP lowering medications. The study groups were well matched in terms of baseline demographics, glaucoma status, medication use, and baseline IOP. Hengerer FH, Auffarth GU, Riffel C, et al.
“I like the bypass procedure better than an extirpation procedure and combination procedures because, to me, the meshwork might hold some mechanism of action in IOP reduction,” he says. So, it’s a little bewildering, but each surgeon is doing his or her own empirical testing. In terms of the latest iStent iteration, there’s recent data from Europe on the iStent inject.1 In a prospective, non-randomized, consecutive case series, researchers operated on eyes with primary open-angle glaucoma, in addition to other types. All eyes underwent ab interno iStent inject implantation as a sole procedure.
Category I codes, used for goniotomy (65820) or viscocanalostomy (66174), have more consistent reimbursement numbers. The prospective HORIZON trial, sponsored by Ivantis, analyzed the Hydrus device when used in conjunction with cataract surgery, with cataract surgery alone used as a control. The authors acknowledged the limitations of unmasked postoperative examinations but conclude that these findings suggest that trabecular MIGS devices may play an important role in managing IOP and reducing the need for hypotensive medication. Third, it also tensions the canal tissue, improving physiological outflow.” According to Dr. Crandall, a recent trial that compared the Hydrus to the iStent used the original iStent, not the iStent inject. “If the Hydrus did better than the single iStent, that shouldn’t be a surprise; the Hydrus accesses at least 90 degrees of the canal, so its odds of accessing one or more outflow channels is much greater. The advantage of Hydrus is the tri-modal mechanism. 3-year HORIZON results. 2. For this prospective randomized study, the researchers included 152 patients (152 eyes) who were between 45 and 84 years old. Copyright © 2020 Jobson Medical Information LLC unless otherwise noted. Adv Ther 2019;36:7:1606-1617. Conclusion The Hydrus has a lot of potential,” says Dr. Samuelson. First, it provides a direct inlet into the canal because the tail end of the Hydrus resides in the anterior chamber. But for me personally, I use goniotomy or the Kahook Dual Blade in a lot of scenarios because it’s probably the most versatile procedure. In the future, that might be an option for us, but in the meantime, we’re left with having to remove the trabecular meshwork either through a goniotomy with some kind of a blade procedure or ab interno trabeculectomy with a catheter. I’ve probably done 100 of them post-approval here. The researchers say there were “minimal” adverse events and CDVA was stable through 36 months.
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